Optimisation des doses administrees lors de perfusions intraveineuses d'aciclovir en pediatrieAciclovir iniusions: optimization of administered doses in children

摘要

In our hospital, the pediatrie haematology unit nurses use a volume of 0. 9% NaCl ranging from 10 to 40 mL to perform saline lineflush after acyclovir infusion. An effective flush can optimize the administered dose. We carried out a study to determine the volume of 0. 9% NaCl required for an efficient flush. We manufactured a low concentration infusion bag (Bag 1 - C_(1-0) theoreticalapprox850 mg/L) and a high concentration infusion bag (Bag 2 - C_2.0 theoretical" 5400 mg/L) of acyclovir. Acyclovir concentrations at the end of the infusion set was assessed using HPLC, just after administration, and after 20, 30, 40 and 50 mL of saline flush. A decrease by 95% of concentration at the end of infusion set compared to the initial infusion bag concentration shows an effective saline flush and an optimisation of the drug administration (5% error is acceptable). The initial bag concentrations were measured (C_(1-0) = 878 and C_(2-0) = 5467 mg/L). After 20 mL of saline flush, bag 7 concentration decreased by 75.4% and bag 2 concentration by 78.7 %. After 30 mL, these levels had decreased respectively by 97.6% and 97.0% and after 40 mL, 99.8% and 99.7%. After 50 mL, the concentration at the infusion set extremity was less than 0.02 mg/L (detection limit of the acidovir HPLC assay). A volume of 30 mL offered a good flush but 40 mL provided greater security. Pharmacist skills allowed to develop a protocol designed to standardize the nurses practices and promoted therapy optimization. It is now recommended to perform an effective flush with 40 mL of0. 9% Sodium Chloride after acyclovir infusions.